Falls in older people

Bristol Community Health supports the Department of Health objectives to reduce the number of older people who fall and sustain injury. The National Institute for Clinical Excellence (NICE) describes a fall as “an event whereby an individual comes to rest on the ground or another lower level with or without loss of consciousness.”

If an older person has fallen they should initially be screened for acute illness including a falls blood screen which involves thyroid, full blood count, electrolytes, liver function tests, calcium, glucose, vitamin B12 and folate. 

Falls assessments

Bristol Community Health services identify patients who need a multifactorial falls risk assessment using the following guideline:

Older people who have more than one fall in the last 12 months or have difficulty with balance or walking or present for medical attention following a fall will benefit from a multifactorial falls risk assessment.

This assessment is documented using the tool which can be downloaded from the left hand side of this page. This is central to communication with the GP and other staff, easy to review and reduces duplication of assessment.

How to access this assessment

The following services are in day-to-day contact with older people and can identify patients who need a multifactorial falls risk assessment:

Intermediate care and reablement – for falls associated with acute medical illness admission avoidance and multi-disciplinary rehabilitation.

Community healthcare teamscommunity matrons, community nurses, and community nurses for older people.

Community therapy services

Physiotherapy at home for a full balance assessment and physical/mechanical issues related to falls, provision of evidence based exercise programmes, walking aids and advice for carers.

Occupational therapy – intervention within patients’ own homes for home hazard and Activity Daily Living assessment, equipment provision and advice for carers.

Musculoskeletal outpatient Physiotherapy –for post fracture-management and musculo-skeletal conditions who can be seen in an outpatient clinic.

Strength and balance classes – the service provides targeted physiotherapy group exercise for adults who are at risk of falling or have been referred following a fall.

Falls specialist nurse

Our falls specialist nurse provides non-urgent comprehensive geriatric assessment for complex patients at risk of recurrent falls, who are registered with a Bristol GP and who have already been screened for any unstable medical problems. She will then agree an action plan for further investigation or risk reduction with the patient and refer on to other services as necessary.

If you are a clinician or GP and you wish to refer a patient to our falls specialist nurse, please send a brief medical summary or letter, via the confidential fax number below or via post to the address listed below. Referrals are not accepted directly from care homes.

Please indicate what you hope to achieve from the assessment and ensure that the routine Falls Blood tests have been completed.

Ruth Cowell, Falls Specialist Nurse
Knowle Clinic,
Broadfield Road,
Bristol BS4 2UH

Tel No: 0117 9190290
Mobile: 07767 220 976
Fax 0117 9190296

Medical assessment at a specialist secondary care clinic

This is appropriate for:

  • Patients with suspected syncope or with symptoms of dizziness.
  • Patients with recurrent falls who have had a multi-factorial risk assessment and no-cause has been identified by community assessment, or are falling despite interventions to manage the risk.

Please do not refer patients who only need physiotherapy/ occupational therapy assessment/intervention to the hospital clinic. In general patients who have had a hospital assessment for falls within 24 months do not benefit from a repeat referral.

Useful resources

The Age UK website provides helpful information for patients regarding falls prevention.

This helpful video from the Chartered Society of Physiotherapy shows some simple exercises that can help falls prevention.

Tell us what you think

Bristol Community Health would like to learn from your experience of this service. Your comments and suggestions will help us see what we are doing well and what we could improve. To give feedback please click here.